Monday, October 20, 2014

Living with Ebola

Two reports. One from an American doctor in Liberia, in the core of the epidemic. And one from the U.S…

LIBERIA

“You no longer see people dying in the streets… The riots have calmed down. There isn’t the panic there was at the beginning, but the cases continue to rise. The paradox is that everything on the surface feels normal, but in the neighborhoods this infection is still blazing away and people are still dying of it.

…By nature, Liberians are ebullient people. They like to laugh and hug and shake hands and touch. But there’s not as much laughter, and there’s no shaking hands. And there’s certainly no hugging.

“Everywhere you go, you have to wash your hands and disinfect your feet. At some of the larger buildings, they take your temperature. That’s the way business is conducted now. There aren’t many people going out and doing things like shopping or visiting restaurants. People just don’t want to be exposed to others.

“You can’t control the disease until you detect and isolate every single case… The patients are very sick. It’s a very painful disease. It can bring people to their knees with violent vomiting and diarrhea… We’re opening community care centers so that patients with a fever and who are presenting with symptoms can go to a smaller treatment unit close by, instead of going to some of the larger centers farther away. We believe a lot of people are still staying at home. They see the treatment units as a place you go to die.”

UNITED STATES

“Despite the fact that (the first Ebola patient in the U.S.) was a lone man under scrupulous, first-world care, with the eyes of the entire nation on him, his R0 – the average number of people someone with a disease will infect, was 2, just like that of your average Liberian Ebola victim. One carrier; two infections. He passed the virus to nurse Pham and to another hospital worker, Amber Joy Vinson, who flew from Cleveland to Dallas with a low-grade fever before being diagnosed.”

“At a deeper level, the Ebola outbreak is a crisis not for Obama and his administration, but for elite institutions. Because once more they have been exposed as either corrupt, incompetent, or both. And that’s the most panic-inducing part.

What normal people can see and imagine is that three Ebola cases have severely stressed the system. Washington is scrambling, the Centers for Disease Control is embarrassed, local hospitals are rushing to learn protocols and get in all necessary equipment. Nurses groups and unions have been enraged, the public alarmed—and all this after only three cases.

What would it look like if there were 300? That is not a big number in a nation of over 300 million. Yet it would leave the system hyperstressed, and hyperstressed things break down.

How many people and professionals have been involved in the treatment, transport, tracking, monitoring, isolation and public-information aspects of the three people who became sick? Again, what if it were 300—could we fully track, treat and handle all those cases? If scores of people begin over the next few weeks going to hospital emergency rooms with Ebola, how many of their doctors, nurses, orderlies, office staffers, communications workers and technicians would continue to report to their jobs? All of them at first, then most of them. But as things became more ragged, pressured and dangerous, would they continue?

This is why people are concerned. They can imagine how all this could turn south so fast, with only a few hundred cases. This is why the White House claims that we will not have a widespread breakout is fatuous: Even a limited breakout would take us into uncharted territory.

THREE BIG QUESTIONS ABOUT EBOLA

- There are no known good treatments to offer patients and their contacts–just supportive care, quarantine and isolation (for example to maintain hydration, but there’s no treatment that can make the disease go away. Antibiotics don’t work because it’s a virus; the antiviral treatment Ribavirin that works on some other hemorrhagic fevers isn’t effective against Ebola.)

- It is not known how this virus works in the human body. There are animal models that provide some glimpses, but to study humans you have to be able to do research in the middle of a raging outbreak of a rare disease. It was recently learned, for example, that it doesn’t always cause extensive bleeding. That’s why its name was changed from “Ebola hemorrhagic fever” to the simpler “Ebola virus disease.”

- It is not known how the virus spreads in the wild. Probably it circulates in bats and is occasionally transmitted to other animals, including humans, as a dead-end host–but the disease is so rare we don’t have a good way of studying it in the wild. Recently a group of ecologists started collecting bats from the local population in Guinea (where Ebola has started multiple times), but their results are not yet published.

- As a rare disease that has never killed more than thousands, it has not been a focus of vaccine or treatment development (and therefore there is NO vaccine or treatment that has passed the experimental stage – none in early human trials). This is simple economics versus the level of safety and effectiveness testing required to get FDA or EU approval – where 5-10 years of testing and BILLIONS of dollars of results studies are necessary to get approval.

4 comments:

Though one hopes (heaven forbid) that Eloba doesn't effect us, what can Jews do if an outbreak prevents Jews from doing Tahara let alone forbid families of the deceased from burying the bodies as well as being unable to prevent authorities from cremating those who dead from in an outbreak?

A very interesting halachic question. I expanded the question: what are the halachic burial considerations if a guf has become physically dangerous to handle? Examples might be (G-d forbid) a guf with chemical exposure, significant deterioration or damage making a tahara not feasible (such as a death due to war), or as in the question where the guf may harbor an infectious agent?

Outside my knowledge, but I've forwarded it to several rabbonim who might be able to answer. I'll let you know.

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